Category Archives: learning disabilities

The months of rumours, leaks and speculation are over; the Comprehensive Spending Review has finally been announced. As expected, for social care, it does not make for fun reading.

Here are some of my immediate thoughts, based on Chancellor George Osborne’s speech and a (very) swift look at the spending review document. While the review obviously affects everyone in some way, I’m going to try to focus on the impact it could have on people with mental health issues and/or learning disabilities.

Firstly, it should be noted that there is very little geared specifically to people with learning disabilities and/or mental health issues. For instance, specific mentions of ‘learning disability’ (or disabilities) does not get one mention and ‘mental health’ only 2. I didn’t expect there to be; today is the day for grand statements, with the detail to come at a later date.

In terms of what was said, while Osborne promised an extra £2 billion for social care in the next five years, including £1 billion to aid joint working between health and social care, he mentioned that this would help older people – no mention of adults with disabilities.

Also, BBC health reporter Nick Triggle worries this could be more or less cancelled out by the increasing demand of the aging population.

Meanwhile, benefit reform will ensure that it “always pay to work”, according to Osborne. Benefits are to be capped at no more than the average net wage from 2013 – which will work out to about £500 per week for couple/lone parent household and £350 per week for single adult households – although people receiving Disability Living Allowance are exempt from this.

However, this may well hit people on incapacity benefit/Employment and Support Allowance and other benefits, especially those who are moved onto Jobseeker’s Allowance from ESA. The focus of the welfare reform is evidently on people getting jobs, with benefits cut to make it more of an incentive to work.

There is also a new 12-month time limit proposed for the one million people on ESA in the Work Related Activity Group to find work or face having their benefits cut.

But surely this will be dependent on the jobs being out there for people to take? Many people on ESA would like to take up jobs – part or full-time – but with many businesses not looking to take on employees, and the public sector set to shed 490,000 jobs, there are precious few available and competition for them will be fierce.

The reforms to housing benefit will also hit many people with learning disabilities and/or mental health issues, especially those living in London and the southeast, where property prices are generally higher than in the rest of the UK.

Potentially, the adverse impact of money worries on people with mental health issues or learning disabilities could be immense, as could the upheaval of having to move, if they now cannot afford the rent on their homes. For someone to have to move away from an area they know – including a network of informal support – to somewhere new could have a disastrous effect on a person.

Not all bad news

But the CSR wasn’t all bad for social care; there were a couple of positive notes from the Chancellor.

Firstly, personal budgets are to be extended to people with long-term health conditions, children with disabilities and special educational needs and adult social care. The commitment to personalisation is welcome and, for some people, personal budgets have made a tangible positive difference to their lives. Giving more people the option to do this is a good thing. Whether their budget will be enough to do this is another matter.

Likewise, the commitment to increase talking therapies for people with mental health issues is also to be welcomed.

The government is also going to take forward proposals to invest nationally in mental health liaison services at police stations and courts to intervene at an early stage, diverting mentally ill offenders away from the justice system and into treatment. However, it does carry the caveat ‘subject to business case approval’.

Nevertheless, this is a good move. Far too many people with mental health problems get stuck in the justice system and opportunities for them to access treatment are often lost.

Conclusion

From an initial assessment, people with learning disabilities and/or mental health issues do not fare well out of the CSR, especially in terms of welfare and housing reform. However, I don’t think anyone – regardless of who they are – fares well out of this review.

But there are some crumbs of comfort, especially with expanding personal budgets and talking therapies, although they are probably outweighed by the cuts.

However, to paraphrase Winston Churchill, this is not the end, it is not the beginning of the end, it is the end of the beginning. Next month, government departments will set out business plans to outline how they will implement cuts. This is where the real detailed information about cuts will come at a local level, and we will all find out which departments, services, projects, charities etc will retain funding, be closed, or face hard times.

When the coalition released its emergency Budget in June, the introduction of medical assessments for all Disability Living Allowance (DLA) claimants from 2013-14, with the aim of only paying the benefit for as long as the person needs it, caused much consternation among claimants, their families and disability groups.

Now, the extent of that dismay is becoming clearer. It seems that nearly all people who claim DLA are very or quite concerned about the changes to the benefit being introduced by the coalition government’s Budget, according to a survey by the Essex Coalition for Disabled People (ECDP).

More than half (57%) of respondents fear that their DLA may be taken away under the new assessment rules and 1 in 3 respondents thought it unlikely they would be able to work as a result of the changes.

Nearly 6 in 10 (58%) respondents said the changes were likely to have “a big impact” on their everyday lives, including not getting the support they need (67%) and a negative impact on their family (55%).

For many people receiving it, DLA makes up a significant proportion of their income and is not spent on luxuries, but everyday things that enable them to live their life as they choose, including having a job and, in some cases, paying the bills.

Without it, life would become tough very quickly – they will still need the equipment/services DLA enabled them to buy but have less money to do it with.

Even more so if they were to give up a job because of it, as one respondent quoted in the ECDP report said; “Without my DLA I would lose my adapted car, my independence and my job. DLA supports me to contribute because it enables me to work full time.”

In addition, many service users are also concerned about the closing of the Independent Living Fund to new service users until at least April 2011– something that was not widely flagged when it was announced in May – more than 6 in 10 are very concerned by the changes, particularly around not getting the level of care and support they need (64%) or not being able to live independently (62%).

While this survey was only of 141 people, 93% of which were of working age – and 12% of which had a learning disability and 11% a mental health condition – it nonetheless provides an interesting snapshot of the overwhelmingly negative feelings about the changes.

To bundle DLA and the ILF into the drive to get people off benefits and into work misses the point of them. There is a suspicion among some that the government views DLA as an unemployment benefit, which it isn’t. Also, DLA is not a “scroungers” benefit – the assessment people have to go through in order to receive it is already rigorous.

Some people, such as the example above, rely on DLA to be able to work; to take it from such people and force them back onto benefits seems wrong.

This is something the government should investigate with urgency. Any changes to DLA should not be about cost-cutting, but ensuring disabled people have the means to be able to live their life as they choose and have the same life chances as their able-bodied counterparts. Many people believe the current changes do the opposite and could be disastrous for many people.

Discrimination against people with learning disabilities is still rife in the UK, with a third of people still believing that they cannot get a job or live independently, according to a new survey.

Health and social care provider Turning Point has found that 9 out of 10 people believe people with learning disabilities are still discriminated against, with 51% saying they are the most discriminated against group in society.

This is not necessarily a revelation – everyone involved in the sector knows that it is rife – but does show how much still needs to be done if people with learning disabilities are to be truly integrated into society.

OK, while it is a survey of only 1,100 adults and nobody knows whether it was weighted to get certain results etc – I know some people are sceptical of statistics – but taking these on face value from a reputable source it nonetheless provides snapshot that can at least create a debate about the topic.

From looking at the survey results, a lot of this discrimination seems to be down to a lack of public understanding about people with learning disabilities and how they live.

For instance, the survey found that 8% still expect people with learning disabilities to be cared for in a secure out-of-town hospital, while 23% believe they live in care homes.

Whether these views are borne of ignorance or prejudice, all this shows that information campaigns about learning disabilities need to be redoubled. Some of the findings show a basic lack of knowledge – such as identifying mental illness as a learning disability – that needs to be addressed.

Adam Penwarden, Turning Point’s Director of Learning Disability Services, hits the nail on the head: “As a sector, we need to work together to challenge preconceptions and show what a positive contribution to society people with a learning disability can make. This includes working, living independently and playing an active role within the local community.”

There have been high-profile anti-stigma campaigns for mental health in the past couple of years and perhaps the time has come for a similar campaign for people with learning disabilities.

Another way to break down stigma would be to have someone with learning disabilities become a regular member of the cast of one of the major soap operas. While this may sound flippant, it can work – the Stacey Slater bipolar storyline in Eastenders (which I blogged about previously here) has helped to bring the condition into the mainstream and increase understanding.

Yes, I know Billy and Honey Mitchell had baby Janet, who has Down’s syndrome, but that character has all been written out now. I am thinking more of an adult/teenage character.

While better information about learning disabilities would not be a panacea – stopping discrimination is an ideal only – it would at least eat into those statistics and provide a good basis for further work.

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.”

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

As the new government starts to get itself into gear, one of its key policies seems to be welfare reform and getting people into work – but getting it right, especially for people with disabilities or mental health problems will not be easy.

The idea of welfare reform and ending dependency on it is good – and some would say long overdue – but it has to be ensured that it is fair, especially for people with disabilities or mental health problems who are currently receiving Employment and Support Allowance (ESA)/Incapacity Benefit (IB).

While most people with disabilities or mental health problems want to either return to or gain paid employment, some are not capable of it. Others are capable, but only perhaps certain jobs or part-time hours.

However, the Work Capability Assessment, which determines if someone is capable of work – if they are deemed capable, they are moved onto the £25-a-week lower rate Jobseekers Allowance rather than ESA/IB – is flawed, some groups claim.

For instance, Neil Coyle of the Disability Alliance, calls the Work Capability Assessment ‘unfair and ineffective’ in today’s Daily Mirror.

Meanwhile, Paul Farmer, chief executive of mental health charity Mind, says “the current test is not up to the job of measuring whether people with mental health problems are fit for work.”

The test was trialled among new claimants at the end of 2008, and involves rigorous medical assessments carried out by an independent company. Of the 500,000 tested, only 9% remained on ESA. This test is now set to be rolled out to all 2.6 million claimants.

But this worries Farmer, fearing that people with mental health problems will be incorrectly assessed. “We urge our new Government to review the benefit assessment… so that people aren’t deprived of their benefit and forced to look for work they can’t do.

“Work can be good for mental health, but only when it is suited to the individual. The Government has proposed to sanction anyone turning down ‘reasonable offers of employment’, but people should not be forced to accept work that risks damaging their mental health, putting them back on benefits and back at square one. Sanctioning people who can’t secure an appropriate job misses the point about why they are locked out of work in the first place.”

There are other wrinkles in the government’s plan to get people into work; we are just coming out of a long and deep recession and jobs are scarce and very competitive – 2.5 million people are unemployed remember.

Despite all the efforts of various schemes to tackle stigma against people with disabilities, it does still exist; two thirds of employers are unwilling to offer someone with mental health issues a job, according to Farmer.

A solution that is fair for everyone will not be easy, but if the government is to stick to David Cameron’s quote that ‘that those who can should and those who can’t we will always help’, then this needs to be got right and concerns from such groups need to be considered, to avoid the problems that could arise from trying to get people into jobs that are not suited to them.

What will be in today’s Budget for social care? In the words of magician Paul Daniels, “not a lot”.

The focus has thus far been on stamp duty, fuel duty and measures to help business and stimulate the fragile recovery. It will also be setting the stage for the financial/economic debates in the forthcoming election. Social care hasn’t really had a look in.

From what I can glean, reading around various predictions and what has come from Whitehall so far, the only measure that will directly affect people in receipt of social care is a possible rise in benefits.

While the rises are only expected to be small – 2% on pensions, 1.5% on other benefits – at least the government hasn’t stuck to its usual formula of basing the raise on the RPI inflation rate; last September it stood at -1.4%.

However, I suspect these rises won’t be met with much joy. With the cost of living increasing at the moment – notably food, utilities and fuel – the raise won’t cover it.

Elsewhere, I wonder if the Chancellor will make any reference to the proposed National Care Service or the white paper on adult social care funding – rumoured to be published this week – in his funding plans.

There has been very little mention of this in the pre-Budget build-up, but if the white paper is coming, the Chancellor may give some pointers when he outlines where funds will be going in the coming months.

I will be watching the Budget with interest and will blog and Twitter on this later in the day.

In one of the great pieces of buck-laying of recent times, Sir Roger Singleton, chairman of the Independent Safeguarding Authority, which will run the Vetting and Barring Scheme (VBS) that will check the suitability of people who work with children and vulnerable adults, has laid the blame for the furore around it squarely on the government.

As reported by the BBC (and many others) Sir Roger, when asked if here had been ‘stupidity’ surrounding the way vetting rules were originally applied, replied; “The decisions were made by Parliament so if there was stupidity that’s where it rests.”

So, now we all know who to blame. That will have gone down well with Sir Roger’s employers.

What will have gone down better is Sir Roger’s revisions to the VBS, as set out in his report Drawing the Line, commissioned after the VBS received widespread criticism for being over-prescriptive and too onerous on its release back in September.

Predictably, he has recommended watering down some of the measures, and the government has agreed.

So, one of the major gripes about the VBS, which would require anyone working with children once a month – potentially including parents who regularly give lifts to children to clubs – to register in the scheme, will now only apply to those working with the same children once a week.

Elsewhere, parents will also welcome the assertion that ‘parents exercise their own judgement about who should care for their children that is entirely a private matter in which the scheme should not interfere’.

It also clarifies the rules around school exchange programmes, which had seemed under threat in the original version of the VBS. Now, if they last less than 28 days, they will be exempt.

These revisions make sense and seem to hit a happy medium. Bodies such as teacher’s union the NASUWT and children’s charity Barnardo’s have also welcomed them and neither is shy about criticising the government if they don’t agree with a policy.

But it also has to be remembered that the VBS won’t stop all paedophiles – only the ones who have been previously convicted. However, stopping those with previous convictions will be a big help.

Nevertheless, parents and carers will still have to be vigilant – and the government cannot be held responsible for that.